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Improving clinical outcomes by reducing bleeding in patients with non-ST-elevation acute coronary syndromes.

Publication ,  Journal Article
Budaj, A; Eikelboom, JW; Mehta, SR; Afzal, R; Chrolavicius, S; Bassand, J-P; Fox, KAA; Wallentin, L; Peters, RJG; Granger, CB; Joyner, CD ...
Published in: Eur Heart J
March 2009

AIMS: Bleeding in patients with coronary artery disease has been linked with adverse outcomes. We examined the incidence and outcomes after bleeding in 20 078 patients with acute coronary syndromes (ACS) enrolled in the OASIS-5 trial who were treated with fondaparinux or the low-molecular weight heparin, enoxaparin. METHODS AND RESULTS: Nine hundred and ninety (4.9%) patients developed major bleeding and 423 (2.1%) developed minor bleeding. Fondaparinux compared with enoxaparin reduced fatal bleeding [0.07 vs. 0.22%, relative risk (RR) 0.30, 95% CI: 0.13-0.71], non-fatal major bleeding (2.2 vs. 4.2%, RR 0.52, 95% CI: 0.44-0.61), minor bleeding (1.1 vs. 3.2%, RR 0.34, 95% CI: 0.27-0.42), and need for transfusion (1.8 vs. 3.1%, RR 0.56, 95% CI: 0.47-0.61) during the first 9 days. One of every six deaths during the first 30 days occurred in patients who experienced bleeding. Cox proportional hazards model revealed that major bleeding was associated with about a four-fold increased hazard of death, myocardial infarction, or stroke during the first 30 days and about a three-fold increased hazard during 180 days of follow up. CONCLUSION: Bleeding in patients with ACS is a powerful determinant of fatal and non-fatal outcomes. Reducing the risk of bleeding using a safer anticoagulant strategy during the first 9 days is associated with substantial reductions in morbidity and mortality.

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Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

March 2009

Volume

30

Issue

6

Start / End Page

655 / 661

Location

England

Related Subject Headings

  • Treatment Outcome
  • Stroke
  • Risk Factors
  • Polysaccharides
  • Myocardial Revascularization
  • Myocardial Infarction
  • Male
  • Humans
  • Hemorrhage
  • Fondaparinux
 

Citation

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Budaj, A., Eikelboom, J. W., Mehta, S. R., Afzal, R., Chrolavicius, S., Bassand, J.-P., … OASIS 5 Investigators, . (2009). Improving clinical outcomes by reducing bleeding in patients with non-ST-elevation acute coronary syndromes. Eur Heart J, 30(6), 655–661. https://doi.org/10.1093/eurheartj/ehn358
Budaj, Andrzej, John W. Eikelboom, Shamir R. Mehta, Rizwan Afzal, Susan Chrolavicius, Jean-Pierre Bassand, Keith A. A. Fox, et al. “Improving clinical outcomes by reducing bleeding in patients with non-ST-elevation acute coronary syndromes.Eur Heart J 30, no. 6 (March 2009): 655–61. https://doi.org/10.1093/eurheartj/ehn358.
Budaj A, Eikelboom JW, Mehta SR, Afzal R, Chrolavicius S, Bassand J-P, et al. Improving clinical outcomes by reducing bleeding in patients with non-ST-elevation acute coronary syndromes. Eur Heart J. 2009 Mar;30(6):655–61.
Budaj, Andrzej, et al. “Improving clinical outcomes by reducing bleeding in patients with non-ST-elevation acute coronary syndromes.Eur Heart J, vol. 30, no. 6, Mar. 2009, pp. 655–61. Pubmed, doi:10.1093/eurheartj/ehn358.
Budaj A, Eikelboom JW, Mehta SR, Afzal R, Chrolavicius S, Bassand J-P, Fox KAA, Wallentin L, Peters RJG, Granger CB, Joyner CD, Yusuf S, OASIS 5 Investigators. Improving clinical outcomes by reducing bleeding in patients with non-ST-elevation acute coronary syndromes. Eur Heart J. 2009 Mar;30(6):655–661.
Journal cover image

Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

March 2009

Volume

30

Issue

6

Start / End Page

655 / 661

Location

England

Related Subject Headings

  • Treatment Outcome
  • Stroke
  • Risk Factors
  • Polysaccharides
  • Myocardial Revascularization
  • Myocardial Infarction
  • Male
  • Humans
  • Hemorrhage
  • Fondaparinux